The information on this website is provided to help answer questions that are asked frequently about digital x-ray. While one of our primary goals is to offer systems, we are also in a position to offer valuable information regarding the planning and acquisition of digital x-ray solutions. We believe that helping you learn more about these systems, will ultimately result in a relationship and ongoing business.

What Do You Know About It? It's very interesting that most physicians and medical facility technicians have very little knowledge of "Digital X-ray" except they know they need it if they are going to eliminate x-ray film and move electronic diagnostic images to computer based systems. They also know it's fairly pricey but they don't have any real idea of how pricey. They also believe they will either have to retrofit their existing x-ray systems or replace them (which by the way, isn't necessarily true). I know this because I receive many inquires every week requesting information and pricing to acquire "Digital X-ray" capability.

What Should You Know to Start? There are two basic methods to achieve "Digital X-ray". Computer Radiography (CR) and Direct Radiography (DR). CR is the least expensive and the most easily to implement, DR is more expensive and has much greater performance.

CR Systems. CR generally consist of a CR Reader, PC Console Workstation and CR Cassettes/phosphorous coated plates. The CR process for converting x-ray to digital images is similar to that of film processing. The CR Cassette is placed into the table or chest unit bucky (much the same as a film cassette). The exposure is taken, the cassette is removed from the bucky and taken to the CR Reader. The CR Cassette is then loaded into the CR Reader which reads the phosphorous plate that was in the CR Cassette. The digital image is produced and is now available to be accessed at the PC Console Workstation. The image can be viewed, manipulated, stored and/or sent to another workstation or server where it can be merged with other systems such as PACS (Picture Archiving and Communications System), EHR (Electronic Health Record) and/or similar programs. The image is then erased from the plate and the cassette is returned to the bucky to be available for the next exposure. CR has several advantages over DR. Generally, cost to purchase and implement CR is less than DR. New CR system prices range broadly depending on manufacturer, model, features and options. Most manufacturers offer an entry level desktop system starting at about $20,000. High performance CR systems that processes multiple cassettes simultaneously can sell for more than $100,000. Major suppliers include Carestream (formally Kodak), Konica-Minolta, Fuji and Agfa. CR systems are available pre-owned and refurbished from organizations such as Med Imaging System Sales www.missales.com and NCD Medical www.ncdmedical.com. Refurbished systems also range broadly in price, starting at about $10,000 and on up to $50,000 for high performance systems. Systems can be ordered with multiple cassettes, multiple cassette sizes (similar to film sizes) and with multiple workstations. The second advantage is implementation. Existing x-ray systems do not have to be modified to accept CR cassettes. The CR Reader should be in a convenient location to avoid unnecessary travel to accommodate processing cassettes in the least amount of time. The PC Console Workstation is generally located in the x-ray control room with the x-ray system console allowing for patient information to be shared easily. Another advantage of CR is that it can be shared by multiple systems if volume allows. For example, different CR Cassettes can reside in multiple x-rays systems, in a R/F system (including the spot film device) and accompany a portable x-ray, all at the same time, all using the same CR Reader. Although this would be unusual, at a low volume facility, a minimal investment could provide for "Digital X-Ray" throughout. CR also has several disadvantages. First, compared to DR, the process is slow. The time it takes to remove a CR Cassette, walk it to a CR Reader, insert it and allow 30-60 seconds to process an image, erase the image and return the CR Cassette to the system bucky, elapsed time could be upwards of 3-5 minutes. High volume facilities would be hindered by these cycles and would result in reduced volume. The second disadvantage and growing concern is increased x-ray exposure or dose. CR requires significantly more dose than DR or even film. The industry continues to look closely at CT and other modalities that require excessive dose to achieve image quality, CR is in that group. Lastly, plates have limited life and need to be replaced every 1000-2000 exposures at a cost of approximately $1000 each. The last consideration when acquiring a CR system is that the US Government has mandated regulations which will reduce reimbursements of any study output to CR beginning in 2018 at -7% and will increase to -10% by 2023. Although these do not represent a huge reductions, it is a consideration.

DR Systems. DR is experiencing significant growth at this time. Today's health care industry emphasis is squarely focused on delivering high resolution diagnostic images in seconds to enhance workflow and increase patient throughput and DR is the solution most widely accepted for x-ray. There are several different types of DR technology available which include indirect and direct capture detector devices. Indirect devices employ a scintillator substance that converts x-ray beams to light which in turn is converted to image data. Direct devices convert x-ray beams into image data without having to convert to light first. Direct flat panel detectors use Amorphous Selenium transistors to convert x-ray. These detectors produce high quality images in 2-3 seconds, making them the highest performance devices available, however, they generally require auxiliary cooling devices and have a limited life, significantly shorter than that of competing devices. The most popular detector technology employs Amorphous Silicone transistors with a scintillator that converts light to image data in 3-5 seconds. These detectors are available fixed, tethered and wireless and are available from major manufacturers including Varian, Cannon, Carestream, Toshiba, Samsung, etc. The other DR detector technologies include the use of CCD (Closed Coupled Device) and CMOS (Complimentary Metal Oxide Semiconductor) semiconductors. Both of theses capture devices convert light which is produced when x-ray beams pass through a scintillator. These technologies represent lower cost DR solutions but at the cost of lower performance. The most popular CCD flat panel detector (see NCD DDR) delivers images in 15-60 seconds at prices starting at $25,000, much faster than CR but much slower than Amorphous Silicon detectors. CMOS detectors are currently limited in size, not being available in 14" x 17" or 17" x 17" sizes which are the accepted sizes used in general radiology. The typical DR subsystem is comprised of a flat panel detector (sometimes referred to as a sensor), a PC Console Workstation and acquisition/manipulation/viewing software. Although there are many suppliers who provide similar system features, the key element has become the capability of the DR subsystem to interface the facility x-ray system to the facility PACS (Picture Archiving and Communications System), RIS (Radiology Information System), EHR (Electronic Health Record) and HIS (Hospital Information System). This is important because today's workflow rely's heavily on a system's ability to minimize duplication of information. The patient is admitted by entering basic patient information into the HIS. The patient is treated by a physician and he is able to record the patients condition and treatment in the EHR which received the patient information from the HIS. The patient is then scheduled for testing which is set up in the RIS with testing criteria and patient information it received from the HIS and EHR. The RIS provides testing instructions to the DR, including patient information, test procedures and schedules. This information enables the patient to receive his test and have the results sent to the PACS for diagnostics and review with data also sent to the EHR if desired. The result is that a patient is admitted to a facility, examined, tested and treated using as many as five separate systems working together as an integrated system, much because diagnostic x-ray imaging can now be interfaced to other facility systems because high performance DR is now available. Today's DR retrofit pricing starts at about $30,000 for a single detector system to about $150,000 when purchasing from the major suppliers. It appears the most appealing retrofit DR subsystem is produced by Meridian Medical Technologies and includes software that provides for full integration of the x-ray system to other facility health systems at the most competitive pricing of high performance systems. Meridian DR systems are available from Med Imaging System Sales www.missales.com and from NCD Medical www.ncdmedical.com.

What To Know About X-ray Systems With Digital Output? The first big question for facilities that have existing systems is "can we retrofit a digital solution or do we need to replace our system?" The answer is "yes". Yes you can retrofit your current system and "yes" you should replace your current system, depending on the system and what digital solution you choose. If you have a low powered single phase system (30-40kW) but with a high frequency generator, I would suggest considering a CR solution (if you have both a table and chest unit) or a low cost DR solution (if you have just a single table or single chest unit, not both). It doesn't make much sense to retrofit a $30,000 DR subsystem to a low cost, low volume x-ray system. If your budget is limited and your volume is low, spend $11K-$50K and become digital. This investment will be returned within two years in savings of eliminating film, film duplication, film distribution, film filing and storage, film processor chemicals, service and related resources, not to mention reduced labor costs required to support film. On the other hand, if you have an older single phase powered x-ray system that has enough years that it was produced before high frequency generators became popular, you should seriously consider replacing it. You may have several choices. You could purchase a late model refurbished x-ray system with a refurbished CR system (about $40K) or a refurbished x-ray system with a new low cost DR subsystem (about $65K). If you have budgeting available of $105,000 you can purchase a "new" Meridian MX 100 Universal Arm system with a new 40kW high frequency generator, a high performance DR subsystem, a universal arm support which allows for both table and chest procedures using a single DR detector. At a cost of less than $2000 a month you can own a system that is state of art and will return more than twice that amount every month. Facilities that have late model higher powered (3 phase power/50-80kW HF generator) systems should be considering retrofitting a high performance DR subsystem. These DR retrofits are easily adapted to major brand systems such as GE, Philips, Siemens, Sedecal, CPI, etc. System replacement of older systems can be achieved by acquiring a late model refurbished system with a new DR upgrade or purchasing a new X-ray system with DR integrated. Both refurbished systems and new Meridian Medical x-ray/DR systems are available from Med Imaging System Sales (www.missales.com) and from NCD Medical (www.ncdmedical.com). It is not recommended to consider acquiring an older pre-owned digital system. Detector replacements would be extremely costly and used detectors may be at the end of their life, consequently, making these systems available for purchase inexpensively. Used x-ray systems with new DR systems or new x-ray systems with DR integrated are much safer purchases.

The Latest DR Technology. There has been difficulties in the past interfacing new DR subsystems to existing x-ray systems, both fixed and mobile. The DR detector needed to communicate with the x-ray system generator, so that a signal from the generator would alert the panel that an x-ray exposure was initiated. Once the panel received this signal, it energized and became active to receive and process the exposure. Often the timing between pushing the exposure button, transmitting signals and panel activation were not always in the correct sequence or time frame, requiring set up adjustments. This problem no longer needs to exist. Today's new DR detectors sense the x-ray exposure and activate the DR detector instantly without having to have to communicate with the x-ray generator. The AED (Auto Exposure Detection) feature not only eliminates signal interface communication issues but also eliminates physical wiring connections. A wireless DR detector system with AED, totally eliminates all external cables and wires, allowing the x-ray tech to easily produce digital output from multiple devices by simply sliding the detector into any bucky (table or wall unit) or under the patient for a portable x-ray procedure.

How To Plan to Acquire Digital X-ray? You must first audit your existing systems, determine what systems need to be upgraded, identify which existing software systems need to be interfaced (HIS, EHR, RIS, PACS, etc.) and desired time frame for implementation. You then would want to identify a preferred vendor, remembering only one DR supplier provides full system integration between x-ray and DR and other software for retrofits (Meridian). Most other suppliers provide DR as a separate and non integrated system, requiring double entry of patient data. Some of the major manufacturers also provide integrated DR, however you must purchase a new x-ray system with integrated DR at pricing that is generally 30-50% higher than similar systems provided by Meridian. Lastly and possibly most important you must establish a budget with justifications, financing options and an implementation schedule. Justifications are key to establishing budget. Increased volume, reduced costs and enhanced workflow are the major justifications. Every facility is different, however, all facilities are faced with the same operating conditions and usually easily justify DR.

Portable Digital X-Ray Systems Portable systems are also being retrofitted with DR subsystems. In generally there are two types of portable systems and I prefer to categorize them as portable (those which are light weight and fold up for travel such as a DynaRad) and mobile (those that remain in a facility and many are self propelled such as the GE AMX series). These systems are usually retrofitted with a portable DR detector (wireless or tethered), laptop or tablet PC integrated onto the system and acquisition/viewing/manipulation software. The systems collect image/patient data and can upload it to a facility network for storage and access. Pricing at the low end starts at $45,000 for a refurbished GE AMX 4+ with new wireless DR fully portable system. Pricing can be as high as $105,000 for a new GE mobile system with high performance DR. There are additional pricing levels by mixing refurbished portable mobile x-ray systems with new DR subsystems. The advantages to portable digital x-ray are pretty much the same as fixed systems, reduced time, increased productivity and elimination of costly film processing and resources.

How To Get Immediate Help To Move Forward? Probably the quickest way to get started is to call us and schedule a sit down meeting with you and the decision making staff to determine a plan to move forward. We can offer many different system solutions, we can offer financing options and we can help establish a plan to implement. Call 440.953.4488 or 440.949.5040.

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